South Africa has no single national database to track hospital-acquired infections (HAIs), a major gap that health experts warn is leaving thousands of preventable deaths undetected. The absence of active monitoring and systematic reporting means the true scale of infections contracted inside hospitals remains largely invisible. A 2024 study titledThe Burden of Hospital-Acquired Infections (HAI) in Sub-Saharan Africa: A Systematic Review and Meta-Analysisreveals that 12.9% of patients admitted to hospitals in the region contract deadly hospital-acquired infections.
Globally, HAIs are among the leading causes of morbidity and infections that patients did not have when they were admitted. The study found that pre-term birth, in-dwelling medical devices, antibiotic use and overcrowding are major risk factors, particularly among newborns. Prof Angela Dramowski, head of the clinical unit in general paediatrics at Stellenbosch University’s Faculty of Medicine and Health Sciences, said postmortem data from Chris Hani Baragwanath Academic Hospital revealed that 70% of pre-term babies who died showed laboratory evidence of infection.
“The information currently collected on HAIs is not comprehensive. Most of what we know about the burden of infections in neonatal and maternity settings comes from isolated research, almost all conducted in tertiary hospitals,” Dramowski said. She added that theBabyGermsstudy was the first to provide laboratory-based data on neonatal HAIs, but large-scale, national-level tracking remains nonexistent.
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Dramowski warned that while all hospital deaths are reported, the contribution of infection is often underestimated because many infections are “culture-negative” or lack appropriate laboratory specimens. When infection and antibiotic-resistance data are shared openly, hospital leadership is more likely to take action. It helps direct resources, staff, equipment and funding to where they are most needed.
“We do not have a single national database on neonatal and maternity admissions and outcomes. Such a system would be ideal to track mortality and morbidity trends and identify facilities needing urgent intervention,” she said. Prof Vindana Chibabhai, head of the Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses (CHARM) at the National Institute for Communicable Diseases (NICD), echoed this concern.
“All neonatal deaths are reported to the national department of health, but it is difficult to accurately estimate the number of infection-related deaths since most are ascribed to prematurity. However, a large number of deaths in premature babies are indeed a result of infections,” she said.
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